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coronary microvascular dysfunction

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https://www.readbyqxmd.com/read/28540214/coronary-microvascular-dysfunction-in-women-with-nonobstructive-ischemic-heart-disease-as-assessed-by-positron-emission-tomography
#1
REVIEW
Roxana Campisi, Fernando D Marengo
Traditional approaches for risk assessment of ischemic heart disease (IHD) are based on the physiological consequences of an epicardial coronary stenosis. Of note, normal coronary arteries or nonobstructive coronary artery disease (CAD) is a common finding in women with signs and symptoms of ischemia. Therefore, assessment of risk based on a coronary stenosis approach may fail in women. Positron emission tomography (PET) quantifies absolute myocardial blood flow (MBF) which may help to elucidate other mechanisms involved such as endothelial dysfunction and alterations in the smooth muscle cell relaxation responsible for IHD in women...
April 2017: Cardiovascular Diagnosis and Therapy
https://www.readbyqxmd.com/read/28528579/phosphodiesterase-type-5-inhibition-may-reduce-diastolic-function-in-women-with-ischemia-but-no-obstructive-coronary-artery-disease
#2
Michael D Nelson, Puja K Mehta, Janet Wei, Behzad Sharif, Louise E J Thomson, Daniel Berman, Debiao Li, C Noel Bairey Merz
BACKGROUND: Ischemia, in the absence of obstructive coronary artery disease, is prevalent in women, and associated with increased risk for major cardiovascular events. Coronary microvascular dysfunction is prevalent in these patients, and associated with impaired diastolic function. Despite our general understanding, however, optimal treatment of this cohort remains elusive. METHODS: To address this knowledge gap, we performed an open-label treatment trial to assess whether phosphodiesterase type 5 inhibition improves coronary microvascular perfusion and diastolic function in women with signs and symptoms of ischemia but no evidence of obstructive coronary artery disease...
May 22, 2017: Journal of Medical Case Reports
https://www.readbyqxmd.com/read/28526473/coronary-flow-reserve-is-reduced-in-sarcoidosis
#3
Seref Kul, Gonul Aciksari Kutlu, Tolga Sinan Guvenc, Murat Kavas, Kenan Demircioglu, Yusuf Yilmaz, Halil Ibrahim Yakar, Asiye Kanbay, Sibel Boga, Mustafa Caliskan
BACKGROUND AND AIMS: Sarcoidosis is a multisystem disease with frequent cardiac involvement, albeit manifest cardiac disease is rare. Though epicardial coronary arteries are not frequently involved, microvascular disease is rather common in both symptomatic and asymptomatic patients. The mechanism of microvascular involvement has not been elaborated yet. The aim of this study is to investigate coronary flow velocity reserve (CFVR) using transthoracic echocardiography in patients with sarcoidosis but without known atherosclerotic coronary artery disease or risk factors for atherosclerosis...
May 4, 2017: Atherosclerosis
https://www.readbyqxmd.com/read/28501910/targeting-the-dominant-mechanism-of-coronary-microvascular-dysfunction-with-intracoronary-physiology-tests
#4
REVIEW
Hernán Mejía-Rentería, Nina van der Hoeven, Tim P van de Hoef, Julius Heemelaar, Nicola Ryan, Amir Lerman, Niels van Royen, Javier Escaned
The coronary microcirculation plays a key role in modulating blood supply to the myocardium. Several factors like myocardial oxygen demands, endothelial and neurogenic conditions determine its function. Although there is available evidence supporting microvascular dysfunction as an important cause of myocardial ischaemia, with both prognostic and symptomatic implications, its diagnosis and management in clinical practice is still relegated to a second plane. Both diagnostic and therapeutic approaches are hampered by the broadness of the concept of microvascular dysfunction, which fails addressing the plurality of mechanisms leading to dysfunction...
May 13, 2017: International Journal of Cardiovascular Imaging
https://www.readbyqxmd.com/read/28501350/first-in-man-prolonged-pressure-controlled-intermittent-coronary-sinus-occlusion-to-treat-refractory-left-ventricular-dysfunction-and-ischemia-with-patent-epicardial-coronary-arteries
#5
Federico Pappalardo, Marco B Ancona, Francesco Giannini, Damiano Regazzoli, Antonio Mangieri, Matteo Montorfano, Michele De Bonis, Ottavio Alfieri, Alberto Zangrillo, Anna Mara Scandroglio, Antonio Colombo, Azeem Latib
AIMS: Pressure-controlled Intermittent Coronary Sinus Occlusion (PICSO) intermittently increases the pressure in the cardiac venous outflow tract using a balloon-tipped catheter introduced percutaneously into the coronary sinus. It aims to improve microvascular perfusion in STEMI patients during PCI, thus improving infarct healing. Its successful administration was associated with an improvement in myocardial recovery four months after primary-PCI as compared to control. However, it has never been used in other settings or for a prolonged period...
May 9, 2017: International Journal of Cardiology
https://www.readbyqxmd.com/read/28499911/aging-associated-metabolic-disorder-induces-nox2-activation-and-oxidative-damage-of-endothelial-function
#6
Lampson M Fan, Sarah Cahill-Smith, Li Geng, Junjie Du, Gavin Brooks, Jian-Mei Li
Oxidative stress attributable to the activation of a Nox2-containing NADPH oxidase is involved in the development of vascular diseases and in aging. However, the mechanism of Nox2 activation in normal aging remains unclear. In this study, we used age-matched wild-type (WT) and Nox2 knockout (KO) mice at 3-4 months (young); 11-12 months (middle-aged) and 21-22 months (aging) to investigate age-related metabolic disorders, Nox2 activation and endothelial dysfunction. Compared to young mice, middle-aged and aging WT mice had significant hyperglycaemia, hyperinsulinaemia, increased systemic oxidative stress and higher blood pressure...
May 10, 2017: Free Radical Biology & Medicine
https://www.readbyqxmd.com/read/28482008/the-microcirculation-a-key-player-in-obesity-associated-cardiovascular-disease
#7
Oana Sorop, T Dylan Olver, Jens van de Wouw, Ilkka Heinonen, Richard W van Duin, Dirk J Duncker, Daphne Merkus
It is increasingly recognized that obesity is a risk factor for microvascular disease, i.e. results in structural and functional changes in the microvasculature. This review aims to describe how obesity impacts the microvasculature of visceral adipose tissue, skeletal muscle, heart, brain, kidneys and lungs. These changes involve endothelial dysfunction, which in turn impacts control of vascular tone, contributes to development of microvascular insulin resistance, alters secretion of paracrine factors like nitric oxide and endothelin, but also influences vascular structure and perivascular inflammation...
May 8, 2017: Cardiovascular Research
https://www.readbyqxmd.com/read/28481466/investigation-of-mthfr-gene-c677t-polymorphism-in-cardiac%C3%A2-syndrome-x-patients
#8
Cemre Kandaz, Burak Önal, Deniz Özen, Bülent Demir, A Gökhan Akkan, Sibel Özyazgan
BACKGROUND: Definition of Cardiac Syndrome X (CSX) refers to groups of patients with positive exercise stress test and normal epicardial coronary arteries on coronary angiography accompanied by chest pain. Although the etiology of CSX is not completely understood, there is a common consensus that its pathophysiology may be associated with endothelial dysfunction resulting in impaired coronary flow. Some polymorphisms observed on the MTHFR gene cause inactivation of the MTHFR enzyme, leading to hyperhomocysteinemia and homocysteinuria, which are prominent risk factors of cardiovascular and cerebrovascular diseases...
May 8, 2017: Journal of Clinical Laboratory Analysis
https://www.readbyqxmd.com/read/28473471/are-targeted-therapies-for-diabetic-cardiomyopathy-on-the-horizon
#9
REVIEW
Mitchel Tate, David J Grieve, Rebecca H Ritchie
Diabetes increases the risk of heart failure approximately 2.5-fold, independent of coronary artery disease and other comorbidities. This process, termed diabetic cardiomyopathy, is characterized by initial impairment of left ventricular (LV) relaxation followed by LV contractile dysfunction. Post-mortem examination reveals that human diastolic dysfunction is closely associated with LV damage, including cardiomyocyte hypertrophy, apoptosis and fibrosis, with impaired coronary microvascular perfusion. The pathophysiological mechanisms underpinning the characteristic features of diabetic cardiomyopathy remain poorly understood, although multiple factors including altered lipid metabolism, mitochondrial dysfunction, oxidative stress, endoplasmic reticulum (ER) stress, inflammation, as well as epigenetic changes, are implicated...
May 1, 2017: Clinical Science (1979-)
https://www.readbyqxmd.com/read/28473444/role-of-adipose-tissue-endothelial-adam17-in-age-related-coronary-microvascular-dysfunction
#10
Huijuan Dou, Attila Feher, Alec C Davila, Maritza J Romero, Vijay S Patel, Vinayak M Kamath, Monika Beck Gooz, R Daniel Rudic, Rudolf Lucas, David J Fulton, Neal L Weintraub, Zsolt Bagi
OBJECTIVE: A disintegrin and metalloproteinase ADAM17 (tumor necrosis factor-α [TNF]-converting enzyme) regulates soluble TNF levels. We tested the hypothesis that aging-induced activation in adipose tissue (AT)-expressed ADAM17 contributes to the development of remote coronary microvascular dysfunction in obesity. APPROACH AND RESULTS: Coronary arterioles (CAs, ≈90 µm) from right atrial appendages and mediastinal AT were examined in patients (aged: 69±11 years, BMI: 30...
May 4, 2017: Arteriosclerosis, Thrombosis, and Vascular Biology
https://www.readbyqxmd.com/read/28473401/ranolazine-in-symptomatic-diabetic-patients-without-obstructive-coronary-artery-disease-impact-on-microvascular-and-diastolic-function
#11
Nishant R Shah, Michael K Cheezum, Vikas Veeranna, Stephen J Horgan, Viviany R Taqueti, Venkatesh L Murthy, Courtney Foster, Jon Hainer, Karla M Daniels, Jose Rivero, Amil M Shah, Peter H Stone, David A Morrow, Michael L Steigner, Sharmila Dorbala, Ron Blankstein, Marcelo F Di Carli
BACKGROUND: Treatments for patients with myocardial ischemia in the absence of angiographic obstructive coronary artery disease are limited. In these patients, particularly those with diabetes mellitus, diffuse coronary atherosclerosis and microvascular dysfunction is a common phenotype and may be accompanied by diastolic dysfunction. Our primary aim was to determine whether ranolazine would quantitatively improve exercise-stimulated myocardial blood flow and cardiac function in symptomatic diabetic patients without obstructive coronary artery disease...
May 4, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28455826/subendocardial-viability-ratio-in-patients-with-rheumatoid-arthritis-comparison-with-healthy-controls-and-identification-of-prognostic-factors
#12
Panagiota Anyfanti, Areti Triantafyllou, Eugenia Gkaliagkousi, Georgios Triantafyllou, Nikolaos Koletsos, Sophia Chatzimichailidou, Panagiotis Panagopoulos, Ioannis Botis, Spyros Aslanidis, Stella Douma
Cardiac involvement is common in rheumatoid arthritis. Subendocardial viability ratio (SEVR) is a non-invasive measure of microvascular coronary perfusion, yet it remains unclear whether it is affected in rheumatoid arthritis patients. We additionally sought predictors of SEVR in rheumatoid arthritis among a wide range of disease-related parameters, cardiac and hemodynamic factors, and markers of atherosclerosis, arteriosclerosis, and endothelial dysfunction. SEVR was estimated in rheumatoid arthritis patients and healthy controls by applanation tonometry, which was also used to evaluate arterial stiffness (pulse wave velocity and augmentation index)...
April 28, 2017: Clinical Rheumatology
https://www.readbyqxmd.com/read/28448601/determinants-of-coronary-flow-reserve-in-non-diabetic-patients-with-chest-pain-without-myocardial-perfusion-defects
#13
Helena U Westergren, Erik Michaëlsson, Juuso I Blomster, Tasso Miliotis, Sara Svedlund, Li-Ming Gan
BACKGROUND: Microvascular dysfunction could be responsible for chest pain in patients without myocardial perfusion defects. We evaluated microvascular function using ultrasound-assessed coronary flow reserve (CFR) in patients with chest pain and normal myocardial perfusion scintigram. Secondly, we investigated association between cardiovascular parameters and decreased CFR in a sex specific manner. METHODS: A total of 202 (128 women) non-diabetic patients with chest pain and suspected myocardial ischemia, but without myocardial perfusion defects on myocardial perfusion scintigram, were enrolled and underwent CFR examination and blood sampling...
2017: PloS One
https://www.readbyqxmd.com/read/28439851/exploring-the-pathophysiology-of-takotsubo-cardiomyopathy
#14
REVIEW
Wengen Chen, Vasken Dilsizian
PURPOSE OF REVIEW: The purpose of this review is to explore the pathophysiology of Takotsubo cardiomyopathy by appraising the interplay between myocardial perfusion, function, metabolism, and, particularly, sympathetic innervation. RECENT FINDINGS: A number of hypotheses have been proposed to explain the pathogenesis of Takotsubo cardiomyopathy, which include (1) catecholamine cardiac toxicity, (2) myocardial sympathetic innervation disruption, (3) coronary vasospasm, (4) myocardial microvascular dysfunction, and (5) aborted myocardial infarction...
June 2017: Current Cardiology Reports
https://www.readbyqxmd.com/read/28432157/effect-of-interleukin-6-inhibition-on-coronary-microvascular-and-endothelial-function-in-myocardial-infarction
#15
Espen Holte, Ola Kleveland, Thor Ueland, Gabor Kunszt, Marte Bratlie, Kaspar Broch, Annika E Michelsen, Bjørn Bendz, Brage H Amundsen, Svend Aakhus, Jan Kristian Damås, Lars Gullestad, Pål Aukrust, Rune Wiseth
OBJECTIVE: Interleukin-6 (IL-6) is a driver of inflammation and associated endothelial cell activation in acute coronary syndromes. We evaluated the effect of the IL-6 receptor antagonist tocilizumab on coronary microvascular function and endothelial dysfunction measured by coronary flow reserve (CFR) and markers of endothelial cell activation in patients with non-ST-elevation myocardial infarction (NSTEMI). METHODS: This substudy was part of a two-centre, double-blind, randomised, placebo-controlled trial evaluating the effect of a single dose of tocilizumab in NSTEMI...
April 21, 2017: Heart: Official Journal of the British Cardiac Society
https://www.readbyqxmd.com/read/28429698/coronary-microvascular-dysfunction-equivalent-to-left-main-coronary-artery-disease
#16
Cafer Panç, Mehmet Kocaağa, Onur Erdoğan, Remzi Sarıkaya, Sabahattin Umman
Coronary microvascular dysfunction, also known as cardiac syndrome X, is a clinical syndrome presenting with typical angina and evidence of myocardial ischemia in the absence of flow-limiting stenosis on coronary angiography. Of patients undergoing coronary angiography due to suspected myocardial ischemia, 50% are found to have normal or near-normal coronary arteries. Described in this case report is a patient who developed hypotension and ST segment depressions during treadmill exercise test. Left main coronary artery or multivessel disease was suspected...
April 2017: Türk Kardiyoloji Derneği Arşivi: Türk Kardiyoloji Derneğinin Yayın Organıdır
https://www.readbyqxmd.com/read/28429664/alternative-causes-of-myocardial-ischemia-in-women-an-update-on-spontaneous-coronary-artery-dissection-vasospastic-angina-and-coronary-microvascular-dysfunction
#17
Bina Ahmed, Mark A Creager
Although coronary obstruction due to atherosclerosis is the most common cause of myocardial ischemia, a significant proportion of patients have myocardial ischemia in the absence of obstructive epicardial coronary artery disease (CAD). This finding is more common among women and alternative causes can mediate myocardial ischemia. Abnormalities in vascular structure, alterations in coronary vasomotion and dysfunction of the coronary microcirculation can all cause ischemia in the absence of obstructive CAD due to atherosclerosis...
April 2017: Vascular Medicine
https://www.readbyqxmd.com/read/28420647/incremental-value-of-transthoracic-doppler-echocardiography-assessed-coronary-flow-reserve-in-patients-with-suspected-myocardial-ischemia-undergoing-myocardial-perfusion-scintigraphy
#18
Li-Ming Gan, Sara Svedlund, Ann Wittfeldt, Charlotte Eklund, Sinsia Gao, Göran Matejka, Anders Jeppsson, Per Albertsson, Elmir Omerovic, Amir Lerman
BACKGROUND: Adenosine-assisted transthoracic Doppler-derived coronary flow reserve (TDE-CFR) reflects coronary vascular function. The prognostic and incremental value of left anterior descending coronary artery TDE-CFR above myocardial perfusion scintigraphy in patients with suspected myocardial ischemia has not yet been studied. METHODS AND RESULTS: Three hundred seventy-one patients (mean age, 62.3±8.7 years; 46.8% males) referred to myocardial perfusion scintigraphy attributed to suspected myocardial ischemia were included in the study...
April 18, 2017: Journal of the American Heart Association
https://www.readbyqxmd.com/read/28415836/diabetic-cardiomyopathy-where-we-are-and-where-we-are-going
#19
REVIEW
Wang-Soo Lee, Jaetaek Kim
The global burden of diabetes mellitus and its related complications are currently increasing. Diabetes mellitus affects the heart through various mechanisms including microvascular impairment, metabolic disturbance, subcellular component abnormalities, cardiac autonomic dysfunction, and a maladaptive immune response. Eventually, diabetes mellitus can cause functional and structural changes in the myocardium without coronary artery disease, a disorder known as diabetic cardiomyopathy (DCM). There are many diagnostic tools and management options for DCM, although it is difficult to detect its development and effectively prevent its progression...
May 2017: Korean Journal of Internal Medicine
https://www.readbyqxmd.com/read/28410144/cardiotoxicity-in-oncology-and-coronary-microcirculation-future-challenges-in-theranostics
#20
Giovanni Peretto, Davide Lazzeroni, Carmem L Sartorio, Paolo G Camici
Many of the patients undergoing chemotherapy or radiotherapy for cancer are at increased risk of developing cardiovascular diseases. Recent evidence suggests that cardiac dysfunction and subsequent heart failure are mainly due to vascular toxicity rather than only to due to myocyte toxicity. However, not all of the vascular toxicity of cancer therapies can be explained by epicardial coronary artery disease. In fact, in the last decades, it has been found that myocardial ischemia may occur as a consequence of structural or functional dysfunction of the complex network of vessels, which cannot be seen by a coronary angiography: the coronary microcirculation...
June 1, 2017: Frontiers in Bioscience (Landmark Edition)
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